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A Black Psychiatrist Examines Racism: An Interview with Dr. Alvin F. Poussaint

by Connie Phillips

‘Science for the People’ Vol. 14, No. 2, March-April 1982, p. 21 – 24

Connie Phillips is a teacher and writer. She is a long-time member of Science for the People. 

Mental health care in the US, especially for blacks, neglects issues of race and class–deep-rooted problems of our society. Dr. Alvin F. Poussaint has been Associate Professor of Psychiatry at Children’s Hospital Judge Baker Guidance Center (Boston, MA) for three years. He was Associate Dean of Students at Harvard Medical School for three years after he received his degree in psychiatry from Cornell in New York. Educated mostly in New York, Dr. Poussaint became increasingly politicized as he went through medical school–especially at UCLA, where he was the only black student. He also co-authored Black Child Care.

 SftP: Before we talk about your perspective on mental health care, can you describe your present position and a little about your background? 

Poussaint: I supervise trainees in psychology, social work and psychiatry. In addition to the teaching, I do clinical work, mostly with the Family Support Center, which deals with families in which there has been a death, life-threatening illness or incarceration. We focus on bereavement and grief. We might counsel families in which there has been child abuse when the abuse leads to a death. One of the goals of the clinic is support of the family through a difficult time and help with the psychological problems that accompany the disruption of the family after a death or incarceration. Young children may act out, become anti-social–it’s a critical time to practice preventive psychiatry. 

We consider incarceration an equivalent experience to death because when a father or mother or brother is put in jail for 20 years, that’s a loss. The reactions are similar, but there’s a stigma attached. The Family Support Center is available to families during the crisis and the counseling may continue for more than a year. There’s a sliding scale fee for the services; some families use Medicaid. 

SftP: How does the public know about your services? 

Poussaint: We put out the word in a variety of ways, usually agency or hospital referrals. We have the most difficulty getting referrals from people who have been incarcerated, because people feel it isn’t legitimate for them to seek help. Within that community of people, there’s more suspicion of social service agents, who, they feel, have not served them properly. Incarcerated people are treated as the fringes of society and feel social services will be condescending or rejecting. 

SftP: Can you comment on your training? 

Poussaint: I grew up and did my undergraduate work in New York, to which I still feel attached. When I explored other cities and environments for medical school, I still found New York exciting and interesting. In many New York Schools, including the Ivy League, there’s a lot of overt racism, and you could be very isolated. I stayed in New York because my friends and support were there. 

After I left Columbia, I went to UCLA for my psychiatric internship and training and a new experience. I found UCLA less accepting of minorities despite its reputation as a paradise. I was the first black intern. By this time, though, I was used to being in that position. I was one among the many and had adapted to that. The people in LA were not accustomed to seeing black people. I returned to New York at Cornell. 

SftP: What were your experiences at Harvard like? 

Poussaint: For 2½ years I was Director of Student Affairs as well as Associate Dean of Admissions at Harvard Medical School. There are racial problems at all institutions to work out. By the time I got to Harvard, I was much more of a political person and much more aware of how to move strategically. I had been in the civil rights movement in Mississippi with SNCC, CORE and SCLC.¹ By the time I arrived in Boston, I had acquired a more political and activist orientation. I came expecting not to be comfortable; I came with the understanding that I had a certain job to do. My role was, in part, adversary. That was the reality, unlike in medical school when I wanted to be accepted by everyone else. I wanted to change racial, institutional problems. 

SftP: Are medical schools different today in terms of racism? 

Poussaint: Minority admissions since 1969 have doubled. Harvard has been a leader–in four years, Harvard went from about 1% minority to 20%. It happened because of people like Dr. Ebert, Dr. Eisenberg² and myself. I couldn’t have done it alone without support from key faculty. The faculty endorsed these moves because, even though they were mainly conservative people, they were part of a big institution that felt less threatened than a smaller school. Schools like Harvard also take pride in leading the way. The sense of Dean Ebert was that it was time minorities moved into medicine and Harvard had to do something about it. It was supported by the times we were in; there was a lot of support from faculty and society. Harvard opened up to minority students but not without difficulty and problems. 

I provided counseling for minority students on a variety of issues, including strategical and political ones. We had a strong alliance. I was also very involved with the white students, particularly those who were progressive and activist and supported minority students on their issues. 

SftP: What political issues were you involved in at Harvard? 

Poussaint: The political issues involved recruiting minority students, educating the admissions committee about the issues and problems and trying to re-define the question of merit: who should get in and why; how much credit should someone receive who’s been through very difficult circumstances? We helped the admissions committee modify certain rigidities around standardized testing, becoming more broad and diverse in their notion of colleges. There still is, to a lesser degree, a tendency to deal with certain schools that aren’t mainstream, say black colleges, differently. The first black student to graduate from Harvard with honors came from an all-black state college in Mississippi. There was work getting a wider perspective. 

SftP: What are some issues around blacks and psychiatry? 

Poussaint: There’s no question that psychology is like other fields and institutions in the US in having a lot of racism. Sometimes it’s harder to uncover because it’s clouded by psychological hokus-pokus. Psychologists and psychiatrists have certain kinds of values and prejudices that affect how they evaluate a patient. 

It’s been documented that many white therapists have a tendency to see black patients as schizophrenic and paranoid; this has to do with some of their own projections. 

Blacks are seen by police as being more criminal. Mental health people tend to see blacks as having more severe disorders, being more crazy and more frightened. Therapists often use psychiatric jargon to express the same kinds of images and notions of inferiority in blacks. For instance, a therapist will say that a patient has a ”primitive character structure.” Blacks are more often described as being psychopathic. There is neglect and no understanding of the environmental situation that blacks come from, and a denial that racism even exists in the society. 

There are white therapists who refuse to deal with racism as an issue with black clients. They dismiss it. They see the key issue as how to get along with a mother or father. It’s clearly an individual, intrapsychic orientation to most of psychiatry. As long as that’s so, therapists will be willing to downplay the effects of the environment. It’s a provincial notion of environment. The model of the environment is often mommy, daddy and children in the suburbs. When you take people out of that framework, there’s no understanding of what people have to go through. There is a lot of narrowness. It isn’t just true for blacks, but for other populations. 

In addition to racial bias, I think psychiatry and psychology have a very strong class and educational bias. Therapists often come themselves to be involved with the more educated, more well-to-do standardized American class. Poor people don’t seek out mental health care because of money. The kind of therapy offered is inappropriate for people with different kinds of backgrounds, with different expectations of why they went to see a doctor. 

When I was working at the Columbia Point housing project³ when I first came to Boston, doing outreach, many black families wouldn’t let me into their apartments. When I tried to find out why, they were very afraid of me. They felt that I was going to come in, talk to them, write up a pink paper and lock them up. That was their notion of what psychiatrists did. And that was true, that was real. The only time that population had anything to do with psychiatry was when they heard about a friend or relative being grabbed by the police, taken to a hospital, and a psychiatrist would lock them up. So they see psychiatrists almost in the role of protector of a different sort of society, similar to the police. Frequently, poor people don’t get any service except to be committed to a state hospital. 

SftP: How severely will Reagan’s cutbacks affect mental health care? 

Poussaint: First, the cutbacks will cut down on the number of people going into the mental health field. Students will gravitate towards those fields where they will make the most money because of loans they’re carrying. There will be a change in attitude of society towards minorities because there will be fewer students willing to work with poor people. It’s not going to be rewarded–it will become passé. I see a return to the stigma of being called a “do-gooder”; that there’s something wrong with people who are concerned with society at large. That’s not sophisticated; it’s immature. Bringing a lot of conservative people into government will shape young and old people’s attitudes towards poor people–more blaming the victim and a cynicism about the ability of anyone’s ability to do anything about it. 

I get more calls these days from people who want to discuss the “underclass,” this particular group that will be here forever and there’s nothing to be done about them. For about five years now, people have been asking what makes this ”underclass” behave the way they do. To me that implies that society is unwilling to change the nature of the social system. If you believe in an underclass then what you have to do is control them. More jails are being built so you can not only control but punish them: take away their food stamps, do anything to make it rough on them. There’s no sympathetic attitude towards the have-nots. 

The only hopeful sign is that unemployed people are joining the underclass; people who are looking for a job and want to work but are sleeping in the street. From that group I think you’II find a whole new movement, because people like school teachers are in that group. When the system says it won’t support you, you have to make it on your own. If you have a network of relatives and other people to help you, you may get through; otherwise, you’ll be in deep trouble. Homeless, able-bodied people will become politicized–if they don’t, there’s no hope for them. If you get an alliance between those people and poor people, you may see a whole political movement. That has to happen at some point. 

As long as the administration continues to rule in the direction it is, and particularly if their projections are faulty, which they’re very likely to be, then the whole economic picture will prove to be based on myth. The only thing the administration is reasonably sure about securing are not jobs for people, but their own positions of wealth, their own jobs. Businesses stay happy because they have no commitment to hire more hands. That trend is bad for minorities and poor people, and for white people on the fringes. It’s just going to take longer for the white people to catch on. 

Many whites are voting for measures out of prejudice because they think things like Prop 2½ and Prop 13⁴ are directed against black people when they are really directed against them. Whites go out and vote and think that people on welfare will be kicked out of work and they find they’re out of a job also. They’re going to learn the hard way. 

In terms of cutbacks affecting my work, mental health is a large and neglected part of the total healthcare picture and it always has been. It’s being put aside as less important; it’s considered a luxury and a frill. It’s as if crazy people, like poor people, are responsible for their condition. 

SftP: What about your own clientele and racism? 

Poussaint: Racism has to be dealt with in counseling both black and white clients. It’s always an issue–someone who denies that is either being blind or doesn’t want to see it. 

If I treat a white person in therapy, over time, race will become an issue. It’s in the psyche of all Americans. Black people also use a lot of denial about race. They have to be helped to see how it fits into their lives. My approach is not to help them adjust but to see the issues which help them develop a balance between wanting to take on a battle about it and self-destruction. For instance, if a client is being mistreated on a job and they leave, I have to help them work on maintaining their dignity, maybe bringing about some change. So part of what you’re helping people with is politics and strategy without, at the same time, getting their head chopped off. If a patient feels discriminated against, he or she needs to be helped to understand the issues politically. 

I think people engaged in struggle often deny what the problem is. I’ve had black patients tell me they’ve never experienced racism. When that happens, something is severly wrong. People can have a very narrow notion of what racism is. When they read in a newspaper that a white policeman shot and killed a black ten-year-old, that’s racism. They have to react. If they read that blacks are born genetically inferior and have low IQs, that affects them personally–that’s racism. I have to help them deal with the pain of the experience of denying racism. Racism is always there–it’s always an issue. 

I also have to deal with racism being used in the opposite way. A black patient will sit there and tell you that every problem they have, from constipation to the inability to get along with their girlfriend, is all related to racism. Across the board: flunking a physics test is related to racism. 

Still, I think the race issue is enmeshed in American society, in profound kinds of ways. You can feel it and see it, even in a movie with no blacks. 

If I walk into a room with a black patient, they look up in surprise, then they look pleased–it’s a race issue. If I walk into a room with a white patient, they’re also momentarily surprised. It’s always there. Even with people who work for me. If they’re white, they’re handling a lot for me, political matters, phone calls, patients, and they have to find some balance. Lack of acquaintance with the issues for all people is a serious problem. 

SftP: What kinds of movements are there in psychiatry with respect to racial issues?

Poussaint: A number of years ago, the Black Psychiatric Association of America tried to get the National Institute of Mental Health to declare racism a mental disorder which they refused to do. That would establish racism as an abnormality. That wouldn’t excuse it, but would stigmatize it. Racism wouldn’t be accepted as a normal way of functioning. It’s similar to the struggle gays and women had with psychiatry. 

In Boston, I guess there are about twelve black psychiatrists; nationwide, there are about 500-600. I don’t just recommend black patients to see black doctors–it depends on the problems and the doctor. Black psychiatrists are more organized because they’ve had a battle trying to get minority issues dealt with in training therapists. You can’t always call a person a racist when it’s the whole society that’s responsible. A white psychiatrist who goes through training without ever seeing a black patient, or learning about black issues, will be ignorant when it comes to dealing with a black patient. Even if that person is well-intentioned. 

There was a move to include minority and discrimination issues in all psychiatric training. The American Psychiatric Association approved that for residency programs. Psychiatrists, when they finish their training, are supposed to be capable of serving all people, not just a small segment of the population. That’s been accepted in principle; how much is being done varies. It should be part of the training for all social workers, anybody dealing with people. You leave people with good intentions, grappling on their own with issues after they’ve been propagandized through society and the media. They have difficulty even if they think they’re working it out. After many years, a person may become arrogant about their point of view and unwilling to listen and hear. Psychiatrists have to be trained to deal with race issues because they permeate society, from elementary school. 

Reagan and the boys just decided that it’s okay to give tax exemption to schools that discriminate. That’s like giving people lawful permission to be prejudiced. That issue was handled in the civil rights law back in 1962 which stated that institutions receiving federal funds are not to discriminate. Subtle forms of racism are hard enough to deal with, but accepting open policies is going back to the 1940s. 

SftP: Can you comment on blacks and science in general? 

Poussaint: One of the weaker areas in education is science and math. A major effort has to be made to get black and minority students into science and it has to start in preschool. For traditional reasons, blacks have been pushed into service fields and the entire science area was highly discriminatory. Black students aren’t always able to identify with a white professor and vice versa. Our system is too damning–we don’t like people who stumble. They’ll get wiped out after one or two mistakes. A black student gets a C grade in, say, Chemistry, and is told that they’ll not make it. Pre-med advisors often say that, because a lot of medical schools expect perfect records. As long as that’s done, it’s discrimination against people who come from disadvantaged backgrounds who may have to struggle more psychologically, socially, and academically to make the transitions. Black students don’t get enough encouragement to stick it out. It doesn’t allow for late development, which is common among people from disadvantaged environments. I didn’t learn how to speak well until medical school–I was terrified to speak up in high school… A small thing like that can really interfere with your education, and your relationships with peers and professors. If you don’t know how to talk properly, or you do poorly in a course, then you’re considered dumb and that is just not true. Cultural and traditional ways can interfere with someone’s progress in academic situations. Many fall by the wayside.

>> Back to Vol. 14, No. 2 <<

 

NOTES

1. SNCC: Student Non-Violent Coordinating Committee; CORE: Congress on Racial Equality; SCLC: Southern Christian Leadership Conference.
2. Dr. Ebert was Dean of Harvard Medical School for over ten years. Dr. Eisenberg is a Professor of Psychiatry at Harvard Medical School.
3. The Columbia Point housing project was a primarily minority and low-income project located in the Boston harbor area.
4. Prop. 2½   and Prop. 13 are recent laws passed by referendum in Massachusetts and California, respectively, setting a limit to state property taxes, without reforming the tax system as a whole.